As Alan was resting with his eyes closed laying on his side, Sarah came up behind him and without speaking guided him over onto his belly. She pulled his gown away from his back and shoulders and began to gently rub his shoulder and back with a gentle massage. She spoke quietly to him, “You’re doing so well Alan. Just rest and relax. You will get through the rest of this and I will get you back to my room to stay overnight so you get a good night of rest. I think we should do something special for you this weekend. I really think by the time you leave today, we will have this problem figured out and have a sound plan to keep you healthy and comfortable.”

Dr Young came up alongside Sarah without Alan hearing her approach, “How is our patient doing? Holding up ok?“

In the brief time Alan had known Dr Young, her voice was only associated with embarrassment and discomfort, so just hearing her voice behind him dissolved the soothing tranquillizing effects of the mini massage Sarah was providing.

Sarah answered, “He’s doing ok. He is such a good patient, a real trooper. I was wondering if maybe you could use the pediatric sigmoidoscope when you take a look. His bottom is sore from what he’s endured so far and the thinner scope could make it a whole lot more comfortable for him and perhaps facilitate the exam. It might let you get a more thorough look if he is comfortable and relaxed.”

Alan contemplated how his months with Sarah had the effect of forestalling in his mind his transition to adulthood as he submitted to her in an almost childlike way, reminding him at times of his relationship with his babysitter when he was younger. The suggestion she had just made seemed to capture this impression in words when she suggested the pediatric scope. This embarrassed him of course, but he also felt grateful for her suggesting it. His anus was in fact quite sore, there was no question about that.

Dr Young considered this and agreed, “Good idea, Sarah. I think that’s a win-win proposition — a better exam and a more comfortable patient. You have good clinical instincts and you’re always thinking. Bring Alan across the hall to the endoscopy suite. We will use the flat table. I want him in the knee chest position rather than the drop shelf table. He is young and strong so he should have no trouble maintaining the position and it will give him more freedom of motion so that we can have him move around a bit more to facilitate the passage of the scope and getting a thorough look. We will use the pediatric metal rigid sigmoidoscope, so please get that ready. I don’t like the way the plastic disposable scopes have been performing. I’ll be joining you shortly.”

Sarah rubbed Alan’s shoulders for a another minute and then stopped, “OK my brave boy, let’s get you across the hall and prepared. Do you feel any need to expel any remnant of the enema? We can take make a stop at the restroom in the hallway instead of you using the toilet here.”

“No, I feel pretty empty,” Alan replied, hoping that his sense of emptiness was an accurate reflection of the true state of his bowels. As he got down from the bed, Sarah wrapped one of the blankets around his shoulders to provide some coverage over his backside. She walked him across the hall, holding him by the arm. She could sense that he was already drained and wobbly.

When Alan entered the endoscopy suite with Sarah, it was dimly lit and there was a cushioned table waist high and next to it a wheeled table with an array of shining stainless steel instruments layer out on blue cloth. The one that caught his attention was the missile shaped blunt tipped shaft that had a pistol like handle on it. It was about a foot long and about the thickness of a large thumb. He reckoned he could take the girth of it, but the appearance was very intimidating nonetheless. Sarah saw him staring at it with a look of dread on his face. She rubbed his shoulder reassuringly, “Don’t worry Alan, you have pooped larger diameter stools than that. You can handle it. I know you can.”

Christine was standing there waiting for them and she gave Alan a cheerful smile to reinforce the pep talk that Sarah was delivering. She helped him up onto the table and he sat on the edge with his legs dangling.

Alan was fearful enough that he found these sincere caring words and actions comforting despite the profoundly embarrassing nature of what was being said. He wasn’t quite so sure about Dr Young. She seemed to be more of a strictly business type, and so when she walked in the door to join them, it heightened his anxiety level.

“Alan, let’s get started. I am going to be looking up inside you with a scope. You are going to feel a variety of sensations with this procedure. You will of course be aware of the scope itself in your anus and that will produce perhaps a mild stretching sensation, but thanks to Sarah’s suggestion, we are using a thinner scope designed for children, so you should not have difficulty with that. As I am looking, I will be pumping gas into your bowels to open things and provide more room to see and maneuver. That will produce some pressure and give you a feeling that you need to expel the gas. Try not to, but if some passes, its ok. Finally, because the scope is straight and rigid, but your GI tract bends and curves in places, you will feel a deep pushing and pressure that may become uncomfortable at times.”

With that, she went to the tray of instruments and began donning beige tight fitting gloves as she addressed Sarah and Christine, “OK, let’s get this nice young man into position. Modified knee-chest is sufficient, so supported on his elbows rather than his chest.”

Alan remained still, staring straight ahead as the two young women got on either side of him. Sarah put her hand on his shoulder, “OK Sweetie, turn over then up on your knees.”

Alan slowly twisted over, tangling himself in the blanket that had been around his shoulders and back. Sarah pulled it way allowing the chilly room air to encircle his body as the gown fell to the table as he got onto his hands and knees leaving him essentially completely naked. Sarah recognized this as not right, “Dr Young, can I drape Alan with the blanket and secure it with a towel clamp?”

“Sure, that’ll work fine, Sarah. Here.” She handed Sarah a clamp with curved sharp tong like teeth.

Sarah wrapped the knit white blanket around Alan’s trunk like a sideways hammock and then gathered the two flaps at his waist and snapped the clamp around them to keep it secure there. Alan was now wrapped in the blanket tightly around his waist and then more loosely around his chest and shoulders. It was like an upside down kilt. Being covered like this produced a comforting sensation, but all who were present noticed how this seemed to display his naked bottom even more prominently.

“Alright Alan, here we go.” Dr Young was smearing lubricant on the shining metal shaft of the scope as she spoke. “I’ll have you bear down as I insert the scope. After that, all I need you to do is focus on taking slow even breaths. Understood?”

“OK,” Alan responded quietly with a tremble in his voice. Sarah had gloves on, but they were still clean, so she reached for one of Alan’s hands and held it within hers and gave some firm squeezes.

The room had become very quiet with just the soft whir from the HVAC unit in the ceiling. Alan imagined the three women communicating with each other silently with their eyes when Dr Young quietly spoke, “Okay, team, are we ready?”

Sarah responded, “Yes, good to go,” sharing her assessment that she had Alan prepared and he was as ready as he would ever be.

Dr Young placed a dollop of lubricating jelly on Alan’s anus with her index finger, “A little cold now.” She then raised the scope and switched on the internal light. “Cold pressure now. Push like you’re pooping.”

Alan felt the sensations that Dr Young warned him of, but after the initial penetration of his bottom with the scope, the cold feeling was much more persistent and intense. “Oooh! Oh!”

Sarah rubbed his hand more, “Easy. Relax and let it slide inside you.”

Alan had never been penetrated by a metal object before and the coldness was a surprise to him, “Its so cold!”

Sarah reassured him matter of factly, “Yes, the metal can feel quite cold. Its okay, keep breathing. You’re doing fine.”

The cold persisted as Dr Young advanced the shaft of the scope. Although Alan’s rectum was warming up the segment inside of him, the outer colder portion of the scope kept coming, and it was still cold. The coldness was compounded by the water based lubricant that Dr Young was still generously applying to it as she advanced it more deeply inside him.

Alan then heard some soft sibilant noises behind him. At first it sounded to him like Dr Young was sniffling, but he then felt some pressure subtly build inside his rectum and started to understand. Dr Young confirmed his suspicion, “A little more pressure as I pump some air into your rectum to see better.”

This was a new sensation for Alan. He had had enemas of course, but this felt different — pressure without the heaviness of water. Although it didn’t hurt, it was nevertheless unsettling in that it made him feel the psychological need to react to it so that he did not accidentally expel anything from his bottom, whether it be air, lubricating jelly or leftover enema water. That would be beyond mortifying. To make matters worse, the presence of the scope and abundant lubricant in his anal canal made him feel like he had lost control, that he was open and what went into or out of his bottom was completely under the control of Dr Young. In a futile effort to compensate for this loss of control, his anus tightened around to unyielding metal scope, and that hurt — “Ooh… Ouch!”

Dr Young could see this of course. “Relax Alan, you’re clenching down with you anus and that’s why its hurting. Push out for a few seconds and then refocus on your breathing.”

Sarah took over the coaching, “Push like you are pooping, sweetie. “

Sarah and Dr Young exchanged glances and Dr Young nodded in approval after she saw Alan’s anus loosen its grip on the scope. Sarah conveyed Dr Young’s approval, “Good boy, just like that!”

As Dr Young tried to advance the scope further, Alan had more definite deeper pain. He had not felt this type of pain before. Not sharp, but deep and very unpleasant. “Uhhhh ! “. He lurched forward as if trying to escape from Dr Young’s invasion.

“Sorry Alan. The bend between your anal canal and your rectum is quite sharp and hard to navigate. I am going to pump in more air. That will enable me to turn the corner more comfortably without the scope pushing into the walls so much.”

Dr Young began pumping as she was explaining this to Alan and he heard the familiar hisses and then quickly felt the rectal pressure intensify and began to feel a subtle fullness in his lower belly just above his pubic bone. Some quiet noises came from his abdomen as his bowel was slowly filled with the air. Still, even with the inflation, it was painful when she tried to maneuver the scope around the turns. She withdrew the scope partly and paused, “Alan, I am going to have you shift your position some. If we change to relative positions of your thighs, pelvis and abdomen, we can straighten things out a few degrees. I want you to arch your back and draw your knees underneath yourself and really stick your bottom up as far as you can.

Alan did these three things in sequence. Sarah knew Alan well enough that this increased his level of embarrassment and tried to sooth him with humor, “Its like naked yoga, Alan! You’ve mastered the bare bottomed downward dog!”

Had anyone else said it, Alan would have not taken it well, but with his feelings for Sarah, it was actually cheering him up a little. More importantly, the tactic was successful. It was still a bit painful, but Dr Young was able to advance the full length of the scope. Alan was very aware of its presence and “impaled” was the word that came into his mind. He was audibly huffing in an effort to get more comfortable and also to demonstrate to the team around him that he was cooperating and doing his part. He wanted their approval and also felt they would be more likely prioritize his comfort if he was faithfully following their instructions.

Dr Young examined all that she could see and decided to take some biopsies and washings. Alan was pleasantly surprised that this part caused no added discomfort. He could just hear Dr Young and Christine working quickly behind him as she processed the specimens. When they finished, Dr Young announced that she would start to withdraw the scope but do so slowly so that she could examine the lining on the way out as well. Instead of cold, Alan started to feel a very warm wetness around his anus as the part of the metal scope which had absorbed the heat of his rectum was being withdrawn and contacting the temperature sensitive skin of his anus as it came out. When the tip finally came out, there was a wet slurpy sound as his anus cinched closed. He then felt some warm lubricant ooze down his perineum onto the back of his scrotum. It was just clear glistening clean gel coming out of him, but he could not see that. It felt very messy and his mind automatically assumed it must look messy and this mortified him. It did not help at all when he felt Dr Young wiping it all away with gauze pads as she casually spoke to Sarah, “As soon as I finish wiping his bottom, ease him down into the Sims position. That will help him to pass the gas more easily. I had to pump in quite a bit and it will probably cause some cramps.”

Sarah unsnapped the towel clamp to loosen the blanket around Alan and then gently guided him down onto his side. She moved his legs into a splayed position and turned him partly onto his chest so that his bottom was raised up some . She tucked a blue absorbent pad under his lower hip and then covered him up with the blanket. She then went up to where his head layer on the pillow, and leaned over his head, whispering, “Alan, Sweetie, you did so well! You did it! I’m so proud. Rest. You deserve it. I’m going to get you a fresh warm blanket.” She gently ran her fingers through his hair as she said this, pulling it back behind his ear. It was moist with perspiration and had stuck to his cheek.

Alan almost fell asleep in the few minutes that Sarah was away. The room was dim and the quiet conversation Christine and Dr Young were in as they cleared off the tray had a hypnotic effect on him.

When Sarah returned, she gently unwrapped the blanket on Alan. It had gotten tucked under his legs. She used her hands to shift him about so she could free it. This bit of movement caused a noisy fart to escape from Alan. It ended with a drippy trail of clear lubricant that crossed his lower buttock onto the blue pad that Sarah had wisely put beneath him.

“Whoops!” Sarah quickly reassured him, “Its ok, let the gas out. You’ll feel better more quickly. Trying to hold it in out of modesty is just going to prolong the cramps. Let me me clean you up a bit.”

Sarah wiped the lubricant off Alan’s bottom and then put the warmed blanket on him and tucked it around him a bit. The warmth felt heavenly and the slightly tight tucked-in feeling of the blanket gave him a sense of security. As if on cue from Sarah’s encouragement, another eruption of gas noisily escaped from him, but it was more muffled this time with the blanket over him. Sarah cheered him on, “Good! That’s it. Just let it come out whenever you feel any pressure in your rectum. You can even gently push, but don’t strain.”

Dr Young was finishing up and pulling off her gloves, addressing Sarah as she did this, “Sarah, I want Alan to have a prone and upright abdominal film. This was a difficult scope and so there is a small chance that a perforation occurred and we need to check for that. I placed the radiology order. Wait about 15 minutes before you take him down to radiology. We don’t want to leave a puddle of lubricant on their table for them if we can help it. Most of it will be out of him by then.”

Alan felt so embarrassed to hear this, to have them talk about him in his presence like he was a kid and could not control his own body — and that he was likely to make a mess wherever he went. Sarah understood this instinctively and rubbed his shoulder through the blanket, “Its okay. This is all normal and we all understand. You don’t have to be embarrassed.”

Sarah decided Alan was too woozy to go to radiology by wheelchair, so she left and came back with a gurney and rolled it up alongside the table Alan was on. She raised up the height of the table so that it was level with the gurney and then had Alan scoot over. This produced more embarrassing farts, causing Alan to sigh dejectedly when he layed back down on the gurney.

“Its okay. Really, its okay, Alan. I tell you what, we will stop at the bathroom across the hall and you can sit on the toilet. That might enable you to just empty yourself out and be done with it. Okay?”

Sarah stopped the gurney at the bathroom and helped Alan off. He was shaky on his feet, so she was obligated to help him in and get him on the toilet. Her plan worked so well that as soon as she got Alan sat, and before she could close the door behind them, he noisily trumpeted the last of the gas within him. It was followed by a few drippy plops of the remaining lubricant. Sarah didn’t bother to leave him in privacy. It was all over and done before she could. At least he was able to wipe himself this time. When he stood up to flush, he gazed down into the bowl and was alarmed to see red trails of blood streaking the white porcelain of the toilet bowl down under the water. He gasped and this prompted Sarah to take a step over and peer in. “Don’t worry, it always looks like more than it really is and it’s most likely from road rash from her advancing the scope. Good that we are getting you an X-ray though. Just to be cautious. Let’s get going. I don’t think you have any farts left over for the radiology technician, so relax and enjoy the ride.” Sarah helped Alan climb back up onto the gurney. She pulled up the side rails and wheeled him off down the hallway.